Assessment Of Addiction And Co-Occurring Disorders In A Case ✓ Solved

Assessment of Addiction and Co-occurring Disorders in a Case of Post-Trauma Substance Use

Provide an introduction to your paper making it clear which case you have selected, and include the purpose of the assessment by describing the primary presenting concerns from the scenario. Select and evaluate at least two assessment tools for each of the following: addiction assessment or screening, assessment of co-occurring mental health issues, and assessment of risk of harm. Using scholarly sources, compare the strengths and weaknesses of each assessment and justify selecting the most appropriate tool for the case. Analyze how well each assessment performs with relevant diverse populations, citing research on their cultural applicability. Based on the information provided, justify a provisional diagnosis including DSM criteria met and those requiring additional information. Note what further assessments or information are needed for a definitive diagnosis, considering cultural and contextual factors. Present the diagnosis according to DSM-5, including principal and additional diagnoses, relevant medical conditions, and other conditions that may influence clinical attention. Discuss measures of symptom severity or disability, providing a narrative explanation referencing DSM-5 criteria and appropriate assessment tools. Describe the client's strengths, including support systems, motivation, and health, as relevant to treatment planning. Identify challenges the client faces, such as gaps in support, motivation, physical risks, and potential for harm. Recommend an initial level of care following ASAM criteria, describing the continuum of care and supporting it with scholarly literature. Ensure the assessment considers cultural and contextual factors pertinent to the case scenario.

Sample Paper For Above instruction

Introduction and Case Overview

The case selected for this assessment involves Marifel, a 19-year-old woman of Filipino descent who experienced a traumatic boating accident, leading to physical injuries and subsequent opioid dependency. Her primary presenting concern is her reliance on opioid medications following her accident and her subsequent struggle with potential substance use disorder compounded by trauma-related mental health issues. The purpose of this assessment is to explore appropriate screening and diagnostic tools to evaluate her substance use, mental health, and risk factors, and to determine the most effective level of care to support her recovery.

Assessment Tools for Addiction, Co-occurring Disorders, and Risk

1. Addiction Assessment or Screening

Two common tools for addiction screening include the CAGE-AID questionnaire and the Substance Abuse Subtle Screening Inventory (SASSI-3). The CAGE-AID is a brief, easily administered tool that asks about alcohol or drug use and related problems. It has demonstrated good sensitivity in detecting substance use disorders across diverse populations but may miss subtle cases because of its brevity (Ewing, 1984). The SASSI-3, however, is designed to identify individuals with an alcohol or drug problem, especially those who may deny their issues. It offers higher sensitivity and specificity but is more comprehensive, which may make it less practical in some settings (Miller, 1992). For Marifel’s case, the SASSI-3 might provide a more nuanced understanding of her substance use, especially considering her denial and concealment of pill misuse.

2. Assessment of Co-occurring Mental Health Issue

Assessments like the Beck Depression Inventory (BDI) and the Trauma Symptom Inventory (TSI) are relevant. The BDI is a widely used self-report measure for assessing depression severity, which is common among trauma survivors. The TSI provides a comprehensive assessment of trauma-related symptoms and co-morbid mental health issues like anxiety and dissociation. Considering Marifel’s trauma history, the TSI’s focus on trauma symptoms makes it a valuable tool. Both instruments have been validated across diverse populations, but cultural factors should be considered, as expressions of trauma vary (Finkelhor et al., 2007).

3. Assessment of Risk of Harm

Tools such as the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Risk of Harm Tool by the ASAM Criteria are pertinent. The C-SSRS quantitatively measures suicidal ideation and behavior, offering reliability across diverse populations (Posner et al., 2011). The Risk of Harm Tool, aligned with ASAM guidelines, evaluates potential for self-harm or harm to others, considering environmental factors and client history. Given Marifel’s expressed thoughts of self-harm, the C-SSRS provides a structured way to assess imminent risk, while the broader Risk of Harm Tool contextualizes her risk within her current environment.

Comparison and Selection of Assessment Tools

After evaluating strengths and weaknesses, the SASSI-3 and the TSI stand out for their sensitivity to undetected substance problems and trauma symptoms, respectively. The SASSI-3’s ability to detect denial makes it preferable for Marifel’s scenario, where concealment is evident. The TSI’s comprehensive trauma assessment, validated across cultures, ensures accurate understanding of her mental health status. In contrast, brief tools like CAGE-AID and the Columbia-Suicide Scale, while efficient, may overlook nuanced issues. Therefore, the combination of the SASSI-3 and TSI provides a robust assessment for her case.

Provisional Diagnosis and Diagnostic Considerations

Based on her history and initial assessment, Marifel’s provisional diagnosis may include opioid use disorder (DSM-5 304.00), given her pattern of misusing prescribed pills and obtaining them illicitly, and post-traumatic stress disorder (DSM-5 309.81) related to her accident and loss of her friend. Additional information needed to confirm a diagnosis includes her current functioning, duration of symptoms, and any other co-morbidities like depression or anxiety. Cultural considerations involve understanding her Filipino background, which may influence her expression of distress and help-seeking behaviors. The diagnosis would be refined with further evaluation, including mental health interviews and collateral information.

Diagnosis Formulation and Measurement of Symptom Severity

Her opioid use pattern can be assessed using the Addiction Severity Index (ASI), which measures employment, legal, alcohol, drug use, and psychological status (McLellan et al., 1992). For trauma-related symptoms, tools like the PTSD Checklist for DSM-5 (PCL-5) can quantify severity. These measures will inform the treatment planning and help track progress over time. Formulating her diagnosis requires integrating clinical interview data with instrument findings, considering cultural norms that affect symptom expression.

Client Strengths and Challenges

Marifel demonstrates resilience through her motivation to seek help, evident by her agreement to meet with a counselor. She maintains a supportive family network, including her grandparents, which can be leveraged during treatment. Her physical health, while compromised but improving, also constitutes a strength, indicating recovery potential. Challenges include her denial of her substance use, potential cultural stigma regarding mental health, and risk of self-harm. Addressing these barriers is crucial in developing an effective intervention plan.

Recommended Level of Care

Based on ASAM criteria, Marifel’s initial care level would likely be outpatient or intensive outpatient treatment, considering her substance use severity, trauma history, and support system. Her risk for self-harm and the potential for relapse necessitate close monitoring, with subsequent steps involving transitioning to higher or lower levels of care as she stabilizes. Literature supports that culturally sensitive, multidisciplinary outpatient models effectively address co-occurring disorders in young adults from diverse backgrounds (Kelly et al., 2018).

References

  • Ewing, J. A. (1984). Detecting alcoholism: The CAGE questionnaire. Journal of the American Medical Association, 252(14), 1905–1907.
  • Miller, W. R. (1992). The Substance Abuse Subtle Screening Inventory (SASSI): Manual. SASSI Institute.
  • Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. (2007). The lifetime prevalence of child sexual abuse and victimization: Changes across childhood and adolescence. Journal of Child Sexual Abuse, 16(1), 81–102.
  • Posner, K., Brown, G. K., Allen, J. J., et al. (2011). The Columbia–Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266–1277.
  • McLellan, A. T., Luborsky, L., Woody, G. E., & O'Brien, C. P. (1992). An improved diagnostic evaluation instrument for substance abuse patients. The Addiction Severity Index. Journal of Nervous and Mental Disease, 180(2), 101–111.
  • Kelly, J. F., Stout, R. L., Magill, M., & Tonigan, J. S. (2018). The role of alcoholics anonymous in facilitating spiritual growth and change in drinking behavior. Alcoholism Treatment Quarterly, 36(2), 123–139.
  • Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. (2007). The lifetime prevalence of child sexual abuse and victimization: Changes across childhood and adolescence. Journal of Child Sexual Abuse, 16(1), 81–102.
  • McLellan, A. T., Luborsky, L., Woody, G. E., & O'Brien, C. P. (1992). An improved diagnostic evaluation instrument for substance abuse patients. The Addiction Severity Index. Journal of Nervous and Mental Disease, 180(2), 101–111.
  • Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. (2007). The lifetime prevalence of child sexual abuse and victimization: Changes across childhood and adolescence. Journal of Child Sexual Abuse, 16(1), 81–102.
  • Kelly, J. F., Stout, R. L., Magill, M., & Tonigan, J. S. (2018). The role of alcoholics anonymous in facilitating spiritual growth and change in drinking behavior. Alcoholism Treatment Quarterly, 36(2), 123–139.

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